What can be learned from the experience of recipients of disability benefits – both cash and in-kind – in Israel?
In Israel, elderly who are functionally disabled may receive assistance with their daily needs in one of two ways:
Under the Community Long-term Care Insurance (CLTCI) Law, long-term care services are provided in kind (i.e. the right to receive a formal service) to elderly who are functionally disabled in activities of daily living.
Under the Disability Insurance Law, a special services benefit is provided in cash (a cash grant whose use is unrestricted) to disabled adults of all ages. When these adults reach old age, in fact, most of them prefer to continue receiving the cash benefit, rather than shifting to an in-kind benefit.
This study examines the implications of the type of benefit – cash or in-kind – for the care of the disabled elderly and the response to their needs, by comparing recipients of the two types of benefit. We compared the use of formal services and receipt of informal assistance, satisfaction with care, unmet needs, and the preferences of the elderly and their informal care providers with respect to the type of benefit.
Use of services. Significant differences were found in the receipt of formal assistance with personal care and household management, arising from how the benefit was provided. More than 90% of the elderly recipients of the in-kind benefit receive assistance with personal care from a formal caregiver. In contrast, only about one-third of the elderly recipients of the cash benefit used it to employ a formal caregiver; most of them received such assistance from relatives. The same is true for assistance with household management. However, family members were extensively involved in caring for elderly recipients of both types of benefit.
Unmet needs. No difference was found in reports of unmet needs between the recipients of the two types of benefit. Elderly recipients of both types of benefit reported a need for more assistance. Accordingly, in both groups, more than three-quarters of the informal caregivers reported being heavily burdened.
The type of benefit preferred. More than 90% of the cash benefit recipients expressed interest in continuing to receive a cash benefit. In-kind benefit recipients were divided in their preferences: 58% preferred continuing to receive services in kind, and 36% preferred a cash benefit. The responses of informal caregivers were similar to those of the elderly. The principal reason cited for preferring an in-kind benefit was an aversion to the process of independently employing a formal caregiver (e.g., finding one, paying wages and social security benefits, arranging for vacation time), which falls on the recipient of a cash benefit. A sense of autonomy and control were among the most notable reasons for preferring a cash benefit (cited by one-third of the recipients of this benefit).
Selected study findings have been presented to forums such as the Knesset’s Labor and Social Committee, whose members are reviewing the implementation of the CLCTI Law and the care of the disabled elderly in general.